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Prepared by...
Virat Sirisanthana, M.D. |
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Department of Pediatrics,
Chiang Mai University
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| Chief Complaint
and Present Illness: A 2-month-old male infant had a 7-day
history of subacute onset of difficulty in breathing, peripheral cyanosis and low grade fever. He was born by vaginal delivery without any complication. His birth weight was 3170 grams. When he was one month old he had diarrhea and was treated as an outpstient. Since then he has been well until this illness. |
| Family History : was not available at the time of admission |
| Physical examination: |
| GA: BW: 3900 grams,
was intubated, mild pale, no jaundice VS: T= 38.4 C (max), RR= 100/min, P = 160/min, Anterior fontanelle 1.5 x 1.5 cm., not bulging Chest: subcostal & intercostal retraction, Lung: clear , no crepitation on auscultation Abdomen: liver 6 cm below RCM , spleen 3 cm below LCM. |
| Laboratory Findings: |
| Complete blood count: Hemoglobin
10.7 g/dl, hematocrit 35 % , platelets 28,000, WBC 40,600, differential:
40 % polys (1% band), 57 % lymphocytes, 2% monocytes, 1% eosinophile, Electrolyte: Na 131 , K 4.9 , Cl 100 , CO2 15 mEq/L, BUN 11 mg% , Cr 0.3 mg% Chest radiograph: (see below). |
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| He was intubated and specimen from modified bronchoalviolar lavage was obtained. | |
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Click to see larger picture of the Wright stain of the specimen |
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Click to see larger picture of the GMS stain of the specimen |
| What is your diagnosis? |
| Further course of illness......... Click here |